Form Sosbs - Charitable Organization Religious Organization Registration - 2012 Page 2
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3State of Arizona
RELIGIOUS ORGANIZATION REGISTRATION
Arizona Secretary of State’s Office
2. Describe the purpose of the charitable organization:
3. Officers and Directors (attach additional sheets if necessary)
Business Address (number and street,
Telephone Number
Title or Office Held
First & Last Name
room/ suite, city/town, state, zip code)
(include area code)
A.
B.
C.
D.
E.
F.
G.
4. Disclosure of Conviction(s) (attach additional sheets if necessary)
Describe below any conviction or plea of no contest to a felony or misdemeanor involving fraud, dishonesty, false statement or the
receipt or the expectation of receipt of anything of pecuniary value or a violation of A.R.S. Title 44, Chapter 9, Article 6, of any employee
or member of the charitable organization.
First & Last Name
Title
Date of Offense (month/day/year)
Place of Offense
Nature of Offense
First & Last Name
Title
Date of Offense (month/day/year)
Place of Offense
Nature of Offense
5. Methods, Locations
Provide a general description that the charitable organization, or any of its solicitors, will use to solicit contributions:
Methods:
mail
telephone
personal contact
radio/television
special events
Other (specify)
membership
newspapers/magazines
internet
grants
Locations:
State of Arizona
National (U.S.A.)
Worldwide
Other (specify)
Office Form SOSBS_Charity_Religious_Org.doc
C hari t abl e Or gani zati on R egi str ation/R enew al Form
Page 2 of 3
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